BACKGROUND: Neuroleptic agents are effective in treating Tourette syndrome (TS). Side effects such as acute myodystonia and oculogyric crisis as well as the risk of delayed dyskinesia have led to search for alternative therapy.OBJECTIVE: To explore the effects of metoclopramide in controlling the symptoms of TS and improving the intelligence and memory function without causing extrapyramidal side effects.DESIGN: Randomized controlled trial and blind method.SETTING: Neurological Department of Xiangya Hospital Affiliated to Central South University; Institute of Traditional Chinese Medicine of Hunan Province; Neurological Department of the First People's Hospital of Nanning City; Public Health College of Central South University.PARTICIPANTS: Fifty patients with TS came from Tic Specialty Clinic,Neurological Department of Xiangya Hospital, between January 2000 and June 2001. Patients and their family members agreed toaccept our medical treatment and reexamination on fixed dates. There were 38 males and 12 females aged 5-21 years with the mean age of (10.4±4.2) years. All of them were divided into metoclopramide group and haloperidol group with 25 in each group.METHODS: Metoclopramide and haloperidol were white tablets bottled without tag (100 tablets of white color medicine in each bottle). The two types of medicine in each bottle were marked Ⅰ or Ⅱ, respectively. The blind method (patients, their parents and evaluation blinded) was used to test the real biochemical nature of the medicine. Medicine was given by a specific doctor on regular days (2, 4, 8, 16 weeks) to patients on their revisit. The daily dose of metoclopramide for body weight was 0.5-2 mg/(kg· d) and haloperidol was 0.05 mg/(kg· d) and was assigned 3-4 times (principle of dose individuality). In addition, TS patients with severe tics in metoclopramide group would receive metoclopramide 10 mg by intramuscular injection twice a day, at the initial treatment for 2-4 days. ①Before and after treatment, TS severity of patients at weeks 2, 4, 8 and 16 was evaluated by YGTSS (the total score was 100 points; the higher the score, the more severe the condition and overall impairment). ② The clinical curative effect of the medicines was evaluated with YGTSS deduction rate before and after treatment. ③ Asberg side-effect rating score: The lower the score, the fewer and milder the side effects. ④ The cognition function was evaluated with WISC score before treatment and after 3 months of treatment. WISC consisted of language and performance components with 11 subtests, while memory scale category had 10 subtests (memory score lower than the standard indicated problem in memory function).MAIN OUTCOME MEASURES: ① Comparison of YGTSS in patients before and after treatment; ② comparison of efficacy in patients of the two groups; ③ comparison of intelligence quotient and memory quotient of patients before and after treatment; ④ adverse events and side effects.RESULTS: Totally 50 patients entered the final analysis. ① Comparison of Tourette' s syndrome in patients before and after treatment: YGTSS score in the two groups decreased significantly after treatment. The comparison of the differences suggested that metoclopramide had better curative effect than haloperidol. In metoclopramide group, YGTSS score was reduced steadily at weeks 2, 4, 8 and 16. In haloperidol group, YGTSS score was also reduced steadily at weeks 2, 8 and 16, but it was similar at week 2 and week 4. ② Comparison of efficacy in patients of the two groups: The total clinical curative effect rate was 92% (23/25) in both groups withoutany difference (P ＞ 0.05). ③ Comparison of intelligence quotient beforeand after treatment: In both metoclopramide group and haloperidol group itwas higher after treatment than before treatment (93.0±15.1, 87.0±14.6; 93.2±17.0, 87.3±13.6, t=3.43, 2.3, P ＜ 0.01). ④ Comparison of memory quo tient of patients before and after treatment: It was higher only in metoclo pramide group after treatment than before treatment (87.8±12.8, 75.8±15.5, t=3.30, P ＜ 0.01). ⑤ Score of Asberg side effects: It was lower in metoclo pramide group than in haloperidol group [(1.00±0.76), (3.24±1.40) points, t=7.05, P ＜ 0.01]. CONCLUSION: The results suggest that metoclopramide is effective in con trolling the symptoms of TS and improving intelligence and memory function. Metoclopramide causes mild side effects, but no extrapyramidal side effects.

OBJECTIVE: To analyze the effects of Astragalous Injection on oxidative stress and micro-inflammatory status in patients undergoing maintenance hemodialysis (MHD). METHODS: Sixty MHD patients were included and randomized into treatment group and control group, with another 10 healthy volunteers as normal control. The patients in the treatment group were treated with Astragalous Injection and the patients in the control group were treated with normal saline for 12 weeks. A spectrophotometric method was used for the measurement of plasma concentrations of oxidative parameters including advanced glycation end products (AGEs), advanced oxidation protein product (AOPP), malondialdehyde (MDA) and vitamin E (Vit E). The content of C-reactive protein (CRP) was evaluated by enzyme-linked immunosorbent assay. RESULTS: Compared with the normal control group, the plasma levels of AGEs, AOPP, MDA and CRP were significantly increased, while plasma level of Vit E was significantly decreased in MHD patients ( P<0.01). After Astragalous Injection treatment, the plasma levels of AGEs, AOPP, MDA and CRP were decreased as compared with the control group ( P<0.01), while there was no significant difference in plasma Vit E level between the treatment group and control group. CONCLUSION: There exist oxidative stress and micro-inflammation in MHD patients. Astragalous Injection can ameliorate the accumulation of oxidative products and micro-inflammatory status, but it has no significant effect on plasma Vit E level.

OBJECTIVES: To quantitatively analyzing the anatomic variants on temporal computed tomography (CT) in congenital external auditory canal stenosis (EACS), congenital aural atresia (CAA), and normal ear structure. METHODS: Through a retrospective study, we analyzed 142 temporal high-resolution CT studies performed in 71 microtia patients. The following 6 parameters were compared among the three groups: Marx classification, medial canal diameter, vertical facial nerve (VFN) anterior displacement, tegmen mastoideum position, tympanic cavity volume, and malleus-incus joint or malleus-incus complex (MIC) area. RESULTS: The results showed that the microtia distributions in the Marx classification in these three groups were significantly different, as 86% (31 of 35) of ears with major microtia (third-degree dysplasia) had an atresia, and in 54.8% (23 of 42) of the minor microtic (first-degree or second-degree) ears, the bony or cartilaginous part of the external auditory canal was stenotic. Measurement data also showed that the potential medial canal diameter of the atresia group was obviously shorter than that of the stenosis group. The VFN anterior displacement and temporomandibular joint backward-shift together lead to medial canal diameters in ears with atresic canals that is smaller than those with stenotic canals. The tegmen mastoideum position was not significantly different between the three groups. CONCLUSION: The mal-development of the external auditory canal is significantly associated with auricle and middle ear developmental anomalies. Compared with CAA ears, EACS have better development of the auricle, canal, tympanic cavity and MIC and relatively safer surgical operation except for the position of the tegmen mastoideum and the VFN.
Classification ; Constriction, Pathologic* ; Ear ; Ear Canal ; Ear, Middle ; Facial Nerve ; Humans ; Joints ; Multidetector Computed Tomography ; Retrospective Studies ; Temporomandibular Joint

Objective To investigate the clinical features and maternal and fetal outcomes of acute pancreatitis in pregnancy(APIP)and the risk factors for disease aggravation,and to establish a predictive model.Methods A retrospective analysis was performed for 52 APIP patients who were admitted to Affiliated Hospital of Zunyi Medical University from January 2017 to December 2022,and according to disease severity,they were divided into mild acute pancreatitis(MAP)group with 32 patients,moderate-severe acute pancreatitis(MSAP)group with 8 patients,and severe acute pancreatitis(SAP)group with 12 patients.The logistic regression analysis was performed for the clinical data of each group,and the receiver operating characteristic(ROC)curves were plotted to assess the value of risk factors in predicting the severity of APIP.A one-way analysis of variance was used for comparison of normally distributed continuous data between multiple groups,and the least significant difference t-test was used for further comparision between two groups.The Kruskal-Wallis H test was used for comparison of non-normally distributed continuous data between multiple groups,and the Wilcoxon rank-sum test was used for further comparision between two groups;the chi-square test was used for comparison of categorical data between groups.Results Of all patients in terms of etiology,26(50%)had hyperlipidemic pancreatitis,20(38.4%)had biliary pancreatitis,and 6(11.5%)had idiopathic pancreatitis.In terms of gestational week,1 patient(1.9%)was in early pregnancy,25(48.1%)were in mid-pregnancy,and 26(50.0%)were in late pregnancy.A total of 10 patients(19.2%)had acute respiratory distress syndrome(ARDS),among whom 9(90%)required respiratory support.There were significant differences between the patients with different severities of APIP in aspartate aminotransferase,alanine aminotransferase,blood urea nitrogen,blood glucose,C-reactive protein(CRP),international normalized ratio(INR),pneumonia,ARDS,sepsis,hepatic insufficiency,and coagulation dysfunction(all P<0.05).The univariate analysis showed that the severity of APIP was associated with blood glucose,blood urea nitrogen,CRP,and pneumonia(all P<0.05),and pneumonia was a risk factor for the aggravation of APIP(odds ratio=18.938,95%confidence interval:1.020—351.747,P=0.048).CRP,blood glucose,blood urea nitrogen,and INR used in combination had a larger area under the ROC curve than each index used alone(0.954 vs 0.778/0.796/0.721/0.801).Conclusion Pneumonia is a risk factor for the aggravation of APIP,and the combination of CRP,blood glucose,blood urea nitrogen,and INR can be used to predict the severity of APIP.

Objective:To evaluate the superior effect of thoracic epidural block (TEB) used for analgesia in patients with severe acute pancreatitis (SAP).Methods:Fifty patients of both sexes, aged 18-64 yr, with SAP, with Japanese severity score (JSS) ≥3, onset time of SAP≤12 h, were divided into conventional analgesia group (group C) and TEB group.Sufentanil was intravenously infused for analgesia in group C. TEB was performed for analgesia in group TEB.In group C, sufentanil was intravenously infused at a rate of 0.2-0.3 μg·kg -1·h -1 after admission to hospital.In group TEB, an epidural catheter was placed at T 9, 10 interspace, and 0.66% lidocaine mixed with 0.33% ropivacaine was epidurally infused at a rate of 3-5 ml/h for 120 h after admission to hospital.Visual analog scale (VAS) score and intra-abdominal pressure (IAP) were recorded at 1, 24, 48, 72 and 120 h of analgesia.HR, respiratory rate (RR), oxygenation index, computed tomography severity index (CTSI), JSS and Ranson scores were recorded at 24, 72 and 120 h of analgesia, and the de-criticalization within 72 h following analgesia was evaluated. Results:Compared with group C, VAS score and IAP were significantly deceased at each time point ( P<0.05), the rate of de-criticalization (60%/90%) was increased ( P<0.05), and Ranson score, CTSI score and JSS score were decreased at 120 h of analgesia in group TEB ( P<0.05). Conclusion:TEB can not only produce good analgesic effect, but also improve the development of the disease, which has superior effect compared with routine analgesia when used for the treatment of SAP.